Acute Kidney Injury Follow-up Falls Short

Three-quarters of patients hospitalized with acute kidney injury in Alberta, Canada did not visit a kidney specialist within 12 months of discharge.

Patients hospitalized with acute kidney injury (AKI) often fail to follow up with nephrologists after discharge, researchers reported in the Clinical Journal of the American Society of Nephrology (CJASN).

“We discovered that there is a substantial disparity between the opinions of nephrologists and actual processes of care for nephrology evaluation of patients after hospitalization with AKI,” co-leader Matthew James, MD, PhD of the Cumming School of Medicine at the University of Calgary in Alberta, Canada, stated in a press release from the journal's publisher, the American Society of Nephrology.

In a survey, Dr James and colleagues asked 145 Canadian nephrologists how likely they were to recommend outpatient nephrology for hypothetical AKI patients. Nephrologists responded that they would “definitely or probably” reevaluate AKI patients in 87% of hypothetical cases. Patients with a history of chronic kidney disease (CKD, 89%), heart failure (92%), or acute dialysis (91%), or subpar recovery of renal function (98%) especially warranted nephrology follow-up in their opinion.

Nephrologists' responses were compared with real-world practice. According to 2005–2014 administrative health data from Alberta, Canada, just 24% of actual patients visited a nephrologist within 12 months of their AKI hospitalization, with a worrisome downtrend in recent years. Guidelines recommend a nephrology visit within 3 months of discharge to assess renal recovery or progression to CKD. Patients with pre-existing CKD (43%) or who consulted with nephrology before (78%) or during hospitalization (41%) were more likely to be seen. Those older than 80 were less likely (20%).

Although many patients did not receive nephrology follow-up, they were attended by at least one other physician after discharge.

“This information is potentially useful to develop strategies to improve transitions in care between the hospital and community after an episode of AKI,” Dr James and his collaborators commented.